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General NPI Number Information
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NPI Number | 1033643606
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Entity Type | Individual
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Provider Name | BRADLEY DE SOUZA MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 4650 W SUNSET BLVD # MS 12
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-660-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 4650 W SUNSET BLVD # MS 12
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-660-2450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 270332
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 270332
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | A169202
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License Number State | CA
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